Regular issueClinical: AblationReversal of outflow tract ventricular premature depolarization–induced cardiomyopathy with ablation: Effect of residual arrhythmia burden and preexisting cardiomyopathy on outcome
Introduction
Ventricular premature depolarizations (VPDs) originating from the right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT) are frequently encountered in clinical practice. Although they occur mostly in patients without structural heart disease, they have been described in the setting of left ventricular cardiomyopathy (LVCM). A few small series have shown that successful ablation of VPDs originating from the RVOT can result in resolution of LVCM, suggesting causality between frequent VPDs and the development of LVCM.1, 2, 3 Despite these seminal observations, limited data exist regarding an association between VPDs from the LVOT and LVCM as well as outcome with ablation in those patients. The impact of residual VPDs or preexisting LVCM on the recovery of LV function after VPD ablation is also unknown.3, 4
The purpose of this study was to examine the safety, efficacy, and long-term effect on LV function of radiofrequency ablation in a relatively large patient population with LVCM and frequent VPDs originating from the RVOT and LVOT. In addition, we sought to examine the long-term effect of ablation in patients with LVCM known to precede the onset of VPDs and the impact of residual VPD frequency on recovery of LV function.
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Inclusion criteria
We retrospectively analyzed 69 consecutive patients with frequent VPDs (>5,000 VPDs per 24 hours) and LVCM, defined as left ventricular ejection fraction (LVEF) <50% referred to our institution for catheter ablation. The predominant VPDs were required to have ECG characteristics suggestive of outflow tract origin (right or left bundle branch morphology, inferior axis, negative in lead aVL). Active ischemia or prior infarction as a cause of cardiomyopathy was ruled out in all cases by history,
Patient characteristics
Of 317 consecutive patients undergoing ablation of outflow tract VPDs at our institution, 69 had LVCM (43 men; mean age 51 ± 16 years) and are the focus of the present investigation. Fifty-two (75%) of the patients had symptomatic VPDs with palpitations, and 17 (25%) patients were referred for ablation of frequent asymptomatic VPDs in the setting of cardiomyopathy. All patients had >5,000 VPDs on 24-hr Holter monitoring (mean 31,975 ± 16,918 [29% ± 13%]). Nineteen (28%) patients had more than
Discussion
We describe the largest series of patients undergoing ablation with RVOT and/or LVOT VPDs and LVCM. Our patients were on stable maximally tolerated medical therapy for treatment of LVCM for at least 6 months prior to ablation. As such, initiation of medical therapy is unlikely to explain the improvement in LVEF observed following ablation. In addition, by using echocardiograms obtained the day postablation, we minimized the uncertainties of LVEF measurement in the setting of frequent ectopy.
The
References (7)
- et al.
Radiofrequency ablation of frequent, idiopathic premature ventricular complexes: comparison with a control group without intervention
Heart Rhythm
(2007) - et al.
Relationship between burden of premature ventricular complexes and left ventricular function
Heart Rhythm
(2010) - et al.
Twelve-lead ECG features to identify ventricular tachycardia arising from the epicardial right ventricle
Heart Rhythm
(2006)
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